Modeling lesion transition dynamics to clinically characterize mpox patients in the Democratic Republic of the Congo

Coinciding with the global outbreak of clade IIb mpox virus (MPXV), the Democratic Republic of the Congo (DRC) recently experienced a rapid surge in mpox cases with clade I MPXV. Clade I MPXV is known to be more fatal, but its clinical characteristics and prognosis differ between patients. Here, we used mathematical modelling to quantify disease progression in a large cohort of mpox patients in the DRC from 2007-2011, particularly focusing on lesion transition dynamics. We further analyzed individuals’ clinical data to find predictive biomarkers of severity of symptoms. Our analysis shows that mpox patients can be stratified into three groups according to symptom severity, and that viral load at symptom onset may serve as a predictor to distinguish groups with the most severe or mild symptoms after progression. Understanding the severity and duration of symptoms in different patients, as characterized by our approach, allows treatment strategies to be improved and individual-specific control measures (e.g isolation strategies based on disease progression) to be developed. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was supported in part by Grant-in-Aid for JSPS Fellows 23KJ1081 (to T.N.); Scientific Research (KAKENHI) B 23H03497 (to S.I.); Grant-in-Aid for Transformative Research Areas 22H05215 (to S.I.); Grant-in-Aid for Challenging Research (Exploratory) 22K19829 (to S.I.); AMED CREST 19gm1310002 (to S.I.); AMED Research Program on Emerging and Re-emerging Infectious Diseases 22fk0108509 (to S.I.), 23fk0108684 (to S.I.), 23fk0108685 (to S.I.); AMED Research Program on HIV/AIDS 22fk0410052 (to S.I.); AMED Program for Basic and Clinical Research on Hepatitis 22fk0210094 (to S.I.); AMED Program on the Innovative Development and the Application of New Drugs for Hepatitis B 22fk0310504h0501 (to S.I.); AMED Strategic Research Program for Brain Sciences 22wm0425011s0302; AMED JP22dm0307009 (to K.A.); JST MIRAI JPMJMI22G1 (to S.I.); Moonshot R&D JPMJMS2021 (to K.A. and S.I.) and JPMJMS2025 (to S.I.); Institute of AI and Beyond at the University of Tokyo (to K.A.); Shin-Nihon of Advanced Medical Research (to S.I.); SECOM Science and Technology Foundation (to S.I.); The Japan Prize Foundation (to S.I.). The collaboration between R.N.T. and S.I. was supported by a Royal Society International Exchange award (grant number IES-R3-193037). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The prospective observational study of the clinical natural history of human MPXV infections at the remote Kole Hospital in the rainforest of the Congo River basin of the DRC, which was conducted from March 2007 until August 2011, was reviewed and approved by the Human Use Committee of the United States Army Medical Research Institute of Infectious Diseases (FY05-13) and the Headquarters, United States Army Medical Research and Development Command Institutional Review Board (IRB), Frederick, MD, USA, as well as the Ethics Committee at the University of Kinshasa School of Public Health (KSPH), Kinshasa, DRC. The present study was approved by the ethics committee of Nagoya University (approval number: Hc 22-07). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors.